eMedicine Specialties > Neurology > Pediatric Neurology

Neonatal Seizures: Follow-up

Author: Raj D Sheth, MD, Professor of Neurology, Mayo College of Medicine; Chief, Division of Pediatric Neurology, Nemours Children's Clinic
Contributor Information and Disclosures

Updated: Nov 16, 2009

Follow-up

Further Inpatient Care

  • Patients with seizures resulting from intracranial hemorrhage should have head circumference measurements performed daily. A rapid increase in head circumference may indicate hydrocephalus.
  • Seizure medication concentrations should be monitored during the acute period. These drugs often are discontinued between ages 3 and 6 months if further seizures have not occurred. A trend toward earlier discontinuation has met with good results.
  • EEG may be helpful in deciding when to stop AEDs.
  • A general recommendation is to use AEDs for 3 months.
    • If the patient remains seizure free then medications may be tapered gradually.
    • If the patient is on 2 AEDs then one should be tapered first before considering withdrawing the other.
    • If seizures recur, then the patient should be placed back on AEDs. The patient may be placed on the original AED, or carbamazepine may be considered.

Further Outpatient Care

  • Neurology outpatient evaluation and follow-up are needed to decide when to discontinue seizure medications.
  • Patients require developmental evaluation for early identification of physical or cognitive deficits. Enrollment in a "birth to 3" program may be indicated. Patients must be monitored carefully for development of contractures; strongly consider a physical medicine/physical therapy referral.
  • Orthopedic evaluations may be appropriate in infants with joint deformities.

Transfer

Mothers in premature labor ideally should be transferred to a facility with a tertiary neonatal intensive care unit. This is more desirable than transfer after birth, since later transfers more commonly result in morbidity.

Complications

Complications of neonatal seizures may include the following:

  • Cerebral palsy
  • Cerebral atrophy
  • Hydrocephalus ex-vacuo
  • Epilepsy
  • Spasticity
  • Feeding difficulties

Prognosis

Prognosis is determined by etiology for neonatal seizures.

  • If EEG background is normal, the prognosis is excellent for seizures to resolve; normal development is likely.
  • Severe EEG background abnormalities indicate poor prognosis; such patients frequently have cerebral palsy and epilepsy.
  • The presence of spikes on EEG is associated with a 30% risk of developing future epilepsy.
  • The prognosis following neonatal seizures that result from isolated subarachnoid hemorrhage is excellent, with 90% of children not having residual neurological deficits.
Pisani et al devised a scoring system for early prognostic assessment after neonatal seizures. Analysis of 106 newborns who had neonatal seizures and were followed prospectively to 24 months' postconceptional age identified 6 independent risk factors for adverse outcome: birth weight, Apgar score at 1 minute, neurologic examination at seizure onset, cerebral ultrasound, efficacy of anticonvulsant therapy, and presence of neonatal status epilepticus. Each variable was scored from 0 to 3 to represent the range from normal to severely abnormal; these were then added together to produce a total composite score, ranging from 0 to 12. A cutoff score of 4 or higher provided the greatest sensitivity and specificity for prediction of adverse neurological outcome.14

Patient Education

For excellent patient education resources, visit eMedicine's Brain and Nervous System Center. Also, see eMedicine's patient education articles Seizures in Children and Seizures Emergencies.

 


More on Neonatal Seizures

Overview: Neonatal Seizures
Differential Diagnoses & Workup: Neonatal Seizures
Treatment & Medication: Neonatal Seizures
Follow-up: Neonatal Seizures
Multimedia: Neonatal Seizures
References
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References

  1. Volpe JJ. Hypoxic-Ischemic Encephalopathy: Biochemical and Physiological Aspects. In: Neurology of the Newborn. 4th ed. Philadelphia: WB Saunders; 2000:217-276.

  2. Scher MS, Trucco GS, Beggarly ME, et al. Neonates with electrically confirmed seizures and possible placental associations. Pediatr Neurol. Jul 1998;19(1):37-41. [Medline].

  3. Silverstein FS, Jensen FE. Neonatal seizures. Ann Neurol. Aug 2007;62(2):112-20. [Medline].

  4. Sheth RD, Hobbs GR, Mullett M. Neonatal seizures: incidence, onset, and etiology by gestational age. J Perinatol. Jan 1999;19(1):40-3. [Medline].

  5. Vigevano F. Benign familial infantile seizures. Brain Dev. Apr 2005;27(3):172-7. [Medline].

  6. Sheth RD, Buckley DJ, Gutierrez AR, et al. Midazolam in the treatment of refractory neonatal seizures. Clin Neuropharmacol. Apr 1996;19(2):165-70. [Medline].

  7. Sheth RD. Electroencephalogram in developmental delay: specific electroclinical syndromes. Semin Pediatr Neurol. Mar 1998;5(1):45-51. [Medline].

  8. Sankar R, Painter MJ. Neonatal seizures: after all these years we still love what doesn't work. Neurology. Mar 8 2005;64(5):776-7. [Medline].

  9. Lombroso CT. Neonatal seizures: gaps between the laboratory and the clinic. Epilepsia. 2007;48 Suppl 2:83-106. [Medline].

  10. Painter MJ, Scher MS, Stein AD, et al. Phenobarbital compared with phenytoin for the treatment of neonatal seizures. N Engl J Med. Aug 12 1999;341(7):485-9. [Medline].

  11. Sheth RD. Electroencephalogram confirmatory rate in neonatal seizures. Pediatr Neurol. Jan 1999;20(1):27-30. [Medline].

  12. Sheth RD. Frequency of neurologic disorders in the neonatal intensive care unit. J Child Neurol. Sep 1998;13(9):424-8. [Medline].

  13. Sheth RD, Bodensteiner JB. Delayed postanoxic encephalopathy: possible role for apoptosis. J Child Neurol. Jul 1998;13(7):347-8. [Medline].

  14. [Best Evidence] Pisani F, Sisti L, Seri S. A scoring system for early prognostic assessment after neonatal seizures. Pediatrics. Oct 2009;124(4):e580-7. [Medline].

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Further Reading

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Keywords

neonatal seizures, benign familial neonatal convulsions, benign neonatal convulsions, fifth day convulsions, fifth day fits, myoclonic seizures, newborn fits, hypoxic-ischemic encephalopathy, intracranial hemorrhage in a newborn, subarachnoid hemorrhage in infants, germinal matrix-intraventricular hemorrhage, subdural hemorrhage, cerebral contusion, metabolic disturbances, hypoglycemia, hypocalcemia, hypomagnesemia, meningitis, encephalitis, herpes encephalitis, toxoplasmosis, cytomegalovirus, CMV infection, lissencephaly, pachygyria, polymicrogyria, linear sebaceous nevus syndrome, benign neonatal seizure syndromes, benign idiopathic neonatal seizures, benign sleep myoclonus

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Contributor Information and Disclosures

Author

Raj D Sheth, MD, Professor of Neurology, Mayo College of Medicine; Chief, Division of Pediatric Neurology, Nemours Children's Clinic
Raj D Sheth, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Neurological Association, and Child Neurology Society
Disclosure: Nothing to disclose.

Medical Editor

Robert Stanley Rust Jr, MD, MA, Thomas E Worrell Jr Professor of Epileptology and Neurology, Co-Director of FE Dreifuss Child Neurology and Epilepsy Clinics, Director, Child Neurology, University of Virginia; Chair-Elect, Child Neurology Section, American Academy of Neurology
Robert Stanley Rust Jr, MD, MA is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, American Neurological Association, Child Neurology Society, International Child Neurology Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Kenneth J Mack, MD, PhD, Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic
Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, and Society for Neuroscience
Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD, Assistant Professor, Department of Pediatrics, Division of Pediatric Neurology, Department of Neurology, Oregon Health and Science University; Consulting Staff, Shriners Hospital for Children
Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

 
 
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